An immediate denture (synonym: immediate prosthesis) is a definitive (final) removable partial or full denture to replace missing teeth. Immediately inserted after a surgical procedure, it requires adaptation to the altered jaw structure after wound healing. During the wound healing phase after tooth extraction (tooth removal), not only the soft tissues covering the jawbone regenerate. Rather, the alveolus (the bony tooth compartment) of the extracted tooth is also restructured, so that the jaw ridge undergoes a change in shape. Only in exceptional cases is it advisable to fit a definitive denture that is to remain in function for several years without waiting for the restructuring processes of wound healing. On the other hand, masticatory function and esthetics must be ensured, and more extensive wound areas must be protected from mechanical stimuli if necessary. If a definitive (final) denture is inserted immediately after a surgical procedure, it must be adapted to the changing jaw shape in the course of wound healing after a few weeks. The time required for the wound to heal is about two months. As a rule, partial dentures are inexpensively manufactured plastic dentures based on PMMA (polymethyl methacrylate), which are attached to the remaining dentition with hand-bent wire clasps and thus largely restore chewing function and esthetics. This simple form of partial denture, without resting on the remaining teeth, is a purely mucosal or gingival restoration (on the mucosa or gums), which transfers the chewing pressure to the alveolar ridge. In the long term, the ridge reacts to this with atrophy (bone regression). In addition, the curved clasps are not very gentle on the cervical area of the clasp tooth in the long term. For the above reasons, this type of restoration is an inexpensive compromise that is only partially beneficial to oral health and should be the exception. The situation is different, however, with an immediatly (immediately) inserted complete denture (full denture), which is used to restore a completely edentulous jaw. This follows the design principles for any full denture that is not fabricated in conjunction with a surgical procedure. A reline with functional marginal design after wound healing can make it a full permanent denture. Definitions: Interim denture – Immediate denture.
According to health insurance guidelines, a distinction must be made between an interim prosthesis and an immediate prosthesis. While the latter is a definitive restoration inserted immediately after surgery, the interim prosthesis merely serves to bridge the time until a definitive (final) denture is fabricated.
Indications (areas of application)
- Restoration of masticatory function, phonetics (speech function) and esthetics after tooth extractions.
- Preservation of vertical jaw relation (distance from the base of the upper jaw to the base of the lower jaw).
- Stabilization of the occlusion (the chewing closure and chewing movements).
- Preventing elongation (outgrowth of a tooth from the jawbone in the absence of opposing dentition).
- Prevent tooth migration and tilting.
- Protection of the surgical wound
Contraindications
- Proven allergy to PMMA (polymethyl methacrylate; a plastic) or other ingredients.
The procedure
I. Dental office – preoperative impressions.
On a date that is far enough in advance of the surgical procedure so that the implant denture can be made in the dental laboratory in the meantime, impressions of the jaw to be restored and the opposing jaw are taken from alginate (impression material). If the planned denture is a full denture, an attempt is already made at this stage to influence the shape of the future denture margins in the sense of a functional margin design by means of functional movements which the patient performs under guidance before the impression material sets (hardens). If necessary, an individual impression tray is fabricated in the dental laboratory on the basis of the first impression, with which a functional impression is taken at a further treatment appointment. The aim of the margin design is to achieve a trouble-free, yet slightly displacing and thus sealing incorporation of the future denture margins into the surrounding soft tissues.With the aid of a bite registration (made of wax or silicone), the positional relationship of the upper and lower jaws is brought into relation to each other. II. laboratory
II.1 Fabrication of a partial implant denture
- Plaster models are made in the dental laboratory based on the impressions.
- The models are articulated based on the bite record (articulator: device used to imitate the position of the jaws in relation to each other and the movements of the temporomandibular joint).
- Etching – The crowns of the teeth intended for extraction are etched (removed) on the plaster model.
- Brace teeth are measured to determine the dental equator (greatest curvature of the tooth crown). Clasps bent by hand are adjusted and fixed on the model. The brackets will later fit the tooth neck below the tooth equator with slight tension.
- The denture base, in which the clasps are anchored and the denture teeth are set up, is first modeled from wax. Regarding the finished plastic base, restrictions on wearing comfort must be accepted in favor of the material strength, since the plastic is not stabilized by a metal framework.
- The wax modeling is implemented in plastic.
- The hardened denture acrylic is finished and final polished.
II.2. fabrication of a total immediat prosthesis.
The fabrication of an immediatetotal prosthesis is largely based on the design principles for any total prosthesis that is not fabricated in temporal relation to a surgical procedure. However, common intermediate steps such as the wax try-in (try-in of teeth initially set up in wax, still provides opportunity for position correction) cannot be performed in this process.
- In the dental laboratory, plaster models are created based on the impressions.
- The models are articulated based on the bite record (articulator: device used to imitate the position of the jaws in relation to each other and the movements of the temporomandibular joint).
- Etching – The crowns of the teeth intended for extraction are etched (removed) on the plaster model.
- The denture base, in which the denture teeth are placed, is first modeled from wax.
- The wax modeling is converted into plastic.
- The hardened denture acrylic is finished and final polished.
III. dental surgery – insertion of the implant denture.
Immediately after the surgical procedure, the patient is provided with the interim prosthesis. Minor corrections to clasps, margins and occlusion (final bite and chewing movements) can be made. The denture base is checked for pressure points, but with the restriction that the patient cannot yet perceive pressure points themselves at this time due to the local anesthesia (local anesthetic) still being administered.
After the procedure
- After the surgical procedure, an appointment for wound and pressure point control is scheduled promptly in the following days.
- Regular checks should also be made in the course of further wound healing to make repeated corrections to the prosthesis fit.
- After completion of wound healing, the denture is adapted to the changed jaw situation by relining.
